EVIDENCE-BASED PRACTICE: STAYING INFORMED AND TRANSLATING RESEARCH INTO PRACTICE AND POLICY

More than a decade ago the Institute of Medicine (IOM) recommended evidence-based practice (EBP) as a core competency (IOM, 2001). EBP is the process of using current research to guide patient care while incorporating patient values and clinical decision making. With the advent of the Patient Protection and Affordable Care Act (ACA) and the formation of Patient-Centered Outcomes Research Institute, advanced practice registered nurses (APRNs) are critical in the transformation of health care delivery systems. As a member of the health care team, APRNs play important roles in patient care, community engagement, and policy development. If an APRN is going to be a competent clinician and participate in redesigning the health care system, then he or she must become a consumer of and/ or participant in research. The APRN not only has to be familiar with current research but also must be able to translate the research into practice.

When examining published research, clinicians need to be aware that there is, on average, a 15-month lag time from completed research outcomes to publication and a 6- to 13-year delay for inclusion in databases and systematic reviews (e.g., Cochrane; Green, 2014). Some studies have reported that the typical time from bench research to implementation into practice is 15 to 20 years (Carpenter et al., 2012; Squires et al., 2011), culminating in only 14% of research that actually reaches clinical practice (Green, 2014).

With an average of 1,800 research papers and 55 randomized control trials (RCTs) published daily or more than 500,000 publications annually (Blair, 2009; Meats, Brassey, Heneghan, & Glasziou, 2007), staying up to date can be challenging for the busy clinician. One source argued that the average family practice clinician would have to spend a minimum of

TABLE 13.1 Examples of E-Mail Updates

Healthcare Update News Service

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MDLinx Family Med

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Medscape Special Report

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Consultant360

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MedPage Today

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Merck Medicus

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DocGuide

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Total E-Clips

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Physician's First Watch

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ADVANCE for Nurses

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Food and Drug Administration

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ContactFDA/Stayfnformed/

GetEmailUpdates/default.htm

Agency for Healthcare Research and

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Quality

Centers for Disease Control and Prevention cdc.gov/Other/emailupdates/

Practice-Based Research Networks

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20 hours a day to stay current (Majid et al, 2011). Although not a perfect solution, e-mail updates can assist the APRN in addressing this complex problem. Table 13.1 provides examples of e-mail updates that provide weekly or daily clinical updates.

In addition to e-mail updates, there are online subscriptions such as Up-To-Date that are updated frequently and provide clinicians with latest evidence-based treatment recommendations. APRNs can also enlist the support of a medical librarian to assist in finding topics of interest. The majority of providers do not know how to search for information that supports clinical decision making (Majid et al., 2011). Developing collaborative relationships with medical librarians can enhance this skill so that retrieval of evidence is easy and the accumulation of useless information and wasted time is avoided. Other strategies to manage the overwhelming amount of new evidence include access to evidence-based journals, which typically scan multiple journals for relevant research or organizing interprofessional journal clubs where recent research can be discussed.

 
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